POS0267 MORTALITY OUTCOME OF ACUTE MYOCARDIAL INFRACTION AND ACUTE HEART FAILURE HOSPITALIZATION IN RHEUMATIC DISEASES PATIENTS PRE-COVID-19 VS. COVID-19 PANDEMIC FROM 2016-2020 NATIONAL INPATIENT SAMPLE (NIS) DATABASE
Authors: Z.Y. LI, S. Huang, S. Gokcebel, A.M. Reginato
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatic diseases such as rheumatoid arthritis (RA) and Systemic lupus erythematosus (SLE) were known for increased prevalence and risk of death from cardiovascular disease (CVD) due to systemic inflammation in conjunction with other environmental risk factors and genetic predispositions.<sup>[1]</sup> The COVID-19 pandemic is of the leading causes for the increased age-adjusted mortality rate in 2020 due to various unforeseeable conditions including unequitable healthcare resource distribution, decrease access to medical treatment other than for COVID-19 infection. <h3>Objectives</h3> To investigate if the presence of the COVID-19 had an impact on the mortality outcome of acute myocardial infraction (AMI) and acute heart failure (AHF) in rheumatic diseases (RDs) including patients with RA, SLE, psoriasis/psoriatic arthritis, gout, myositis and vasculitis, and sarcoidosis in the United States using the NIS inpatient database from 2016-2020. <h3>Methods</h3> Using NIS database from 2016-2020, we identified patients with a primary admission diagnosis of AMI or AHF using ICD-10 codes. For each admission, we calculated ascertained mortality risk. The association of RDs with inpatient mortality was calculated using multivariable logistic regression. Mortality outcomes from 2016-2019 was compared to 2020, which was the year COVID-19 pandemic initiated. <h3>Results</h3> We identified a total of 691,834 AMI/AHF hospitalizations from 2016-2019, of which 39,047 patients had RDs. During the pre-COVID-19 time, the inpatient mortality was significantly higher in the non-RDs group (4.1% vs 3.3%, <i>p</i>=&lt;0.001). In multivariable logistic regression model, after adjusting for age, race, gender, region, income and confounding comorbidities, patients in the RDs group had a lower odd ratio of inpatient mortality in AMI/AHF compared to non-RDs group (OR=0.71, <i>p</i>=&lt;0.001). During the pandemic year, total AMI/AHF hospitalizations were 121,285, and 5,813 of them were patients had RDs. Again the hospitalization mortality was higher in the non-RDs group with clinical significance of <i>p</i>= &lt;0.001 (4.8% vs. 3.4%). Interestingly, in terms of the COVID-19 infection rate, patients the non-RDs group had a higher infection rate when comparing to RDs (25% vs 23%, <i>p</i>=0.047). The odd ratio for AMI/AHF hospitalization mortality was again significantly lower in RDs groups compared to non-RD's group (OR=0.65, <i>p</i>=&lt;0.001). <h3>Conclusion</h3> Based on our analysis, the presence of co-morbid RDs was not associated with an increased mortality in patients hospitalized with AMI/AHF. These results may be attributed to the use of biologic agents in RDs patients in reducing systemic inflammation. The lower COVID-19 infection rate in RDs patients could be related to the early and aggressive implementation of social distancing and telehealth appointments in the US during the COVID-19 pandemic. <h3>Reference</h3> [1]Alhusain, A., &amp; Bruce, I. N. (2013). Cardiovascular risk and inflammatory rheumatic diseases. Clinical medicine (London, England), 13(4), 395–397. https://doi.org/10.7861/clinmedicine.13-4-395 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.